Basic Anatomy & General Movement

Reviewing Our Basic Anatomy

Let’s take a quick look at the biomechanics and anatomy of your spine (Figure 1.0).
The front or anterior part of your spine is smooth and has a backward “C” shape.  The back or posterior part of your spine has an added bone that comes off the back of the vertebra which is known as your spinous processes.  Now in between each vertebra is a gel filled substance which acts as a shock absorber.  The gel filled substance is called the nucleus pulposus. (Figure 1.1 & 1.2)
When someone hears the words disc herination or bulge it is the nucleus pulposus which has begun to leak out from the center of the disc and begins an inflammatory reaction around the outside nerve root.  (Figure 1.3)
Nerve roots are apart of the spinal cord which exits out through the cord which exits out through the intervertebral foramen.  Once nerve root exits out of the foramen it then subdivides into other nerves that supply the rest of our body both muscle and visceral innervations.
Most people do not realize that there are several smaller muscles that lie underneath our large superficial back muscles that have attachment points on the vertebral bodies and spinous processes.  The muscles that attach to the vertebral bodies and the spinous processes are known as the semispinals, the multifidus, the interspinals, the intertransverarii and the rotators.  These five smaller muscles provide stabilization and movement to your vertebral column, your spine.  The movement these muscles produce is slight extension and/or rotation of the individual vertebra.  (Figure 1.4)
 Muscles of the back
We are more familiar with the larger superficial muscles of the back such as the trapezius and the latissmus dorsi muscle.  Now if we were to pull away the superficial muscle layer so we could see the next layer of muscle then we would see the erector spinae muscles. The erector spinae muscles lie in between the superficial and deep muscle layers.  When we do abdominal exercises or exercises in general that might cause harm to our backs we think about utilizing the erector spinae muscles to protect our spine from being injured.  The erector spinae muscles primary action is extension and adds greatly to trunk strength and stability.  (Figure 1.5)
Large muscles of the back
As mentioned before our core extends down to our pubic bone, which is part of your pelvic girdle.  Our pelvis is made up of three bones: the pubic bone, the ilium, and the ischium.  Now since we have a right and a left side, we have two pelvic bones that when connected form the pelvic girdle.  On the ilium there is a smooth surface where the sacrum can attach and in between the two bones is a synovial filled capsule.  (Figure 1.7)
Pelvic bowl
The primary action of the pelvis is anterior and posterior movement.  Even though the pelvic girdle is not part of the spine and has no connection with the abdominal muscles its role in core stabilization is vital.
There are several muscles that make up the pelvic floor but mostly they are divided into two groups, the levator ani and urogenital diaphragm.   The gluteus maximus is not a deep muscle of the pelvic girdle but it is one of the major superficial muscles of the pelvic floor.  The main function of the gluteus maximus is hip extension when contracted.  So when the muscle is put into a stretch position it allows the pelvis to rock posterior so the lumbar curvature may flatten when performing core exercises.  Studies have shown that when core stabilization exercises are performed that there is a sufficient amount of muscle activity being elicited in the gluteus maximus demonstrating the muscle’s importance in core exercises.  When we think about core stabilization we need to remember that our pelvic floor is the center of the core.  Before we begin to contract our abdominal muscles our pelvic floor muscles need to contract first in order for a core stabilization exercise to be performed.  (Figure 1.7)
Pelvic bowl 2
On the outer rim of the ilium there are two attachment points for the quadratus lumborum and the iliopsoas muscles.  The psoas muscle attaches on the anterior vertebral bodies of L4, L3, L2 and L1 and inserts on the lesser trochanter of the femur. (Figure 1.8)
 Deep core muscles
When combined these three muscles aid in stabilizing the spine but their primary function is hip flexion.  Later on we will see how to test these muscles to see if they are strong or weak and how they help us with core stabilization exercises.
If you where to go up to your client or patient and say to them that you are going to train their core muscles they would probably wonder what you are talking about.  But if you told them that you where going to do some abdominal exercises they would probably think “six pack”.  The media has led us to believe that everyone needs to have a “six pack” in order to have trunk strength or better yet core strength.  This is not true.  Like I had mentioned before even athletes need to do core stability exercises in order to enhance their performance because it’s not about strength and power in the distal muscles (the muscles away from our center).  Research has found through surface EMG (electromyography) studies that it is not the combination of the rectus abdominus and the external oblique abdominus muscles that strengthen our core but it is the transverses abdominus and internal oblique abdominus.
If we look at the general anatomy of the abdominal muscles (Figure 1.9) the superficial layer of muscle is made up of the rectus abdominus and external oblique abdominus.  The rectus abdominus runs the length of your torso from under your breastbone to your pubic bone.  The primary action of the rectus abdominus is trunk flexion.  The external oblique abdominus is seen as being the “wings” of the abdomen because they run along the side of the abdomen on an oblique angle.  The external oblique comes around from the posterior lower ribs and wraps its way around to the front where it attaches along the midline of the body.  The primary action of the external oblique is side bending and rotation of the torso.
 Superficial muscles of the core
Now if we peel away the superficial layer and look at the deep muscles of the abdomen we would see the transverse abdominus and the internal oblique abdominus muscles (Figure 1.10).
Back of core muscles
The transverse abdominus muscle is the primary muscle used when we do core stabilization exercises.  We can think of the transverse abdominus muscle as a giant belt because it wraps around our entire trunk and inserts on our spinal column. The primary action of the transverse abdominus is to compress the abdominal contents (organs) when we perform trunk flexion.  The internal oblique abdominus muscle lies underneath the external oblique abdominus muscle but lies at a 90-degree angle.  The primary action of the internal oblique abdominus is side bending as well as trunk flexion.
Now that we have a general understanding of the anatomy, understanding the general movement can become second nature.  So if we were to bend at the waist flexing our spine, we would feel a contraction among our abdominals and a stretch among our erector spinae muscles.  And if we where to extend our back, looking up at the ceiling, we would feel a stretch at our abdominals and a contraction throughout our back.  Now let’s look at a rotational movement.  Go ahead and sit in a chair that can not roll or slide. Place your feet on the floor in front of you so your legs are at a 90 degree position and then cross your arms over your chest.  By sitting in the chair we are able to isolate spinal movement without involving the pelvic girdle.  Now go ahead and twist to the right slowly and go as far as you can without hurting yourself.  What you should feel is the opposite trunk wall muscles stretching, both the external obloquies and the posterior back muscles, while the same side contracts.  When this is done go ahead and repeat the exercise to the opposite side and the same should happen.
But for now let’s look at what we already know by applying our understanding of movement and anatomy to a simple core stabilization exercise.  Lie on the floor or mat with your knees bent and contract your pelvic floor.  When learning to contract your pelvic floor muscles always think about stopping the flow of urine.  Keep your pelvic floor contracted and flatten out our lower back, so it is touching the floor.  As we flatten out our lower back our core stays tighten while our lower back muscles and hip flexors, e.g. Psoas and quadratus lumborum and erector spinae, begin to stretch while the transverse abdominus and internal oblique abdominus contracts.  Then hold the position for five seconds and then relax.
Later we will add to this basic core exercise that will challenge our core muscles and your clients/patients core muscles.  And for more information contact +Heather Gansel of Head-To-Toe Chiropractic.

Never Too Late

As we get older our bodies begin to slow down.  We begin to shrink.  Our hearing starts to go. We start feeling fatigue quickly like when walking up a flight of stairs.  And, the saddest part is when we begin to see our bodies losing muscle strength.  Now I am sure most of you are feeling like you have a doctor for everything.  But I will tell you that with proper exercise you may be able to decrease the frequency in which you see all of your doctors.  
Let me tell you a story:
My client Alex who is 79 suffers with Diabetes, Prostate Cancer, and Intermittent Vascular Claudication.  Alex takes medication for his Diabetes and a baby aspirin every morning.  Now his doctors felt it was necessary even though he is 79 that he should begin a proper exercise regimen and nutritional plan.  See his doctors where worried about one thing, his bone density.  During Alex’s fitness assessment we talked about his various conditions and what we, Fitness Matters, could do to help him.  I told Alex that with weight training and core training (your core is made up of your spinal stabilizers, deep abdominal muscles, pelvic floor muscles and your hip flexors) we should be able to increase his bone density if not stabilize it.  Also, Alex had mentioned how his left shoulder was giving him problems and he was unable to lift the arm up when putting away groceries for his wife.  I informed Alex that with some corrective exercises and Chiropractic treatments I could help correct the problem and he wouldn’t have to feel like he was getting old.  I then brought Alex out to the training floor to test his cardiovascular endurance and his muscle strength.  When I asked Alex which piece of cardio he would like to warm up on he simply said “because I struggle with walking thanks to the pain I get in my legs, I just don’t know”.  I looked at Alex and walked him over to the recumbent bike.  I told Alex that when my grandfather was alive I helped him improve the circulation in his legs with the recumbent bike.  As Alex peddled, I told him that physicians have found that biking on a recumbent bike helps improve circular more than walking.  Reason being, your quadriceps muscles will work harder using more glucose and protein and the blood doesn’t pool as quickly in the lower legs because of the angle you are placed in when sitting in a recumbent bike.  After the bike Alex and I tried some exercises out of the floor.  I discovered that he had a mild case of frozen shoulder.  I told Alex which exercises would be included into his strength training program to help correct the problem.  After we finished on the floor I brought Alex back into my office and we outlined his frequency.   Alex was going to work out three times per week for the next three months.  Well let me just tell you come the third month and Alex was able to decrease the strength/dose of his diabetic medication, he was able to walk around an entire grocery store without getting any pain in his legs and according to his bone density scan his levels went up in his low back and hips. 
Now I sure many of you could relate to this story.  And have similar medical or musculoskeletal conditions or aliments that you may think would prevent you from embarking on an exercise program.  Well it’s never to let to start.  Understanding that when you chose to embark on this journey that you chose wisely.  Meaning that you pick a personal trainer or fitness specialist you want one who works with physicians, one that understands what functional training is and who knows the body especially the physiology.   
Let me back track a bit.  You are probably asking yourselves what is functionally training.  The reason why Alex’s bone density improved so much was because of functioning training.  What people don’t understand is that a machine works only the primary muscle not the other muscles.  Functionally training works your body through multiple plans of motion recreating activities that mimic daily life.   
We were able to work Alex’s balance, core, muscle strength and endurance all through functionally training.  The best part was Alex even lost a few pounds because by stimulating his heart rate we were able to stimulate his metabolic rate which made him feel better when he would eat that steak at Morton’s.  

Therefore as we get older it is very important to continue to exercise simply because you will gain longevity.  For more information on “how to start an exercise program” contact +Heather Gansel

From the CORE

The latest trend in the health and fitness industry is core stabilization.  Even though core stabilization exercises have been used in martial arts, tai chi, yoga and Pilates for many years, core stabilization is now being seen in a new light because of its connection with low back pain. 

            So what is core stabilization?  Core stabilization is creating an awareness of our body’s movement through space by controlling the muscle action through strengthening an individual’s center of gravity. Our core extends from under the breast bone down to the pubic bone and focuses around the lumber spine (low back), pelvis and hip joints.   So what is the purpose of core stabilization?  The primary purpose of practicing core stabilization exercises is to elicit more muscular control over the outside forces acting on the body.  If you think about different sporting events like boxing and karate or exercises like squats and lat pull downs or forms of mediation like yoga and tai chi, all require a person to have core strength because without inner strength they become fatigued faster, imbalanced and their overall performance would decrease.

            In a recent research study at the University of North Carolina, a study was performed on six female college gymnasts to see which muscle groups would elicit a stronger core when performing certain core exercises.  The study concluded that it is not one single exercise that can strengthen your core but a combination of exercises.  In another study done in Denver Colorado, physiotherapists looked at EMG evidence of abdominal muscle activity during pelvic floor contraction.  The study concluded with all pelvic floor activities there is abdominal muscle activity but the greatest contractions were found among the deep muscles of the abdominal cavity (transverses abdominis and internal oblique abdominis) not the superficial abdominal muscles (rectus abdominis and external oblique abdominis).  Also Barbara Headley, MS PT studied people with chronic low back pain and the theory on core stabilization.  Headley found that people with chronic low back pain can benefit from a core stabilization program and significantly reduce their back pain symptoms.  Proving what we already know about the correlation between core stabilization and low back pain, that it is a combination of the deep abdominal muscles, the hip flexors and the deep back muscles that make our core strong not the superficial muscles of our abdomen.

            So if we already know that approximately 70 to 90 percent of our population suffers from low back pain or has suffered from multiple episodes of low back pain.  And we also know that most health and fitness professionals will focus on isolating structures in the low back during the treatment of low back pain then inner strength is the next step to a healthier back. 

             Since recent research has shown us that it does not matter if you are a conditioned athlete or someone who routinely exercises or even if you do not exercise at all, if you do not have core strength and stability then the chances of you becoming injured will increase.

            So ask your local chiropractor, personal trainer, yoga instructor, Pilate’s instructor, or fitness specialist about how you can strengthen your core. 


The season is approaching where we begin to experience all types of pain from the holiday season.  Whether it’s from the stress of shopping for loves, being over worked just for that holiday bonus or from shoveling the snow, we all experience some form of joint pain.  During the winter months the most common type of pain is back pain and especially after last year’s snow fall I am sure most of you out there understand exactly what I am saying.  We have to remember that during these winter months we must take care of our backs in order to prevent further injury to our body.

Listed below are several ways to maintain a healthy back during the crazy holiday season.

Take time to stretch.  Stress is more or less carried in our backs.  For some it lingers in our low backs and for others it rests in between the shoulder blades.  A simply stretch can help reduce the amount of tension in these areas. A nice stretch that is easy to perform is to lie on the floor on your back and let your arms reach over your head as your legs stretch out in the opposite direction.  As you do this take a few deep breaths to enhance the feel.

Lift Properly.  No matter if we are shoveling snow or bringing up the Christmas/Chanukah decorations from the basement we need to remember to lift properly.  Remember to bend with the knees not the back.  Even when we are shoveling away all the heavy snow that has fallen bending with your knees will make all the difference come later that day.

Exercise.  Exercise is an important tool that we can use to maintain a healthy back.  The most important types of back exercises are ones that are going to encourage core strength and spinal stability.  Simply exercises like pelvic tilts are a perfect example of back exercise.  There are many more back exercises that can be mentioned here but ask your trainer about some of these other back exercises so you can maintain a healthy back.

Seek Chiropractic Care.  If your back is troubling you during the holiday season from all the stress and preparation that goes on then do not want for the symptoms to simply go away seek chiropractic attention before the symptoms get worse.  If you do happen get back symptoms during the holiday remember this simple fact: always use ice and if you are going to use heat always end in ice for the last five minutes.

If you have further questions about how you can maintain a healthy back as these winter months approach please feel free to ask Dr. Heather K. Gansel.

Neural Firing & Functional Movement

We know from our studies in general anatomy that every muscle and visceral organ is innervated by our nervous system.  Our nervous system is divided into two systems the somatic and autonomic.  We are more familiar with the autonomic system because it is subdivided into the parasympathetic and sympathetic.  The autonomic system is what creates the flight or fight response in our bodies.  The parasympathetic and sympathetic systems are more complex systems to understand because the nerve signal is not sent directly to the organ, gland or artery/vein first.  The signal goes through a ray of pathways until the signal is finally delivered to its desired destination. The somatic system is less complex because the nerve signal is sent straight from the axon to the muscle. (Figure 1.11)  In the health and fitness profession we are more concerned with the somatic system because our lively hood is based on shaping and retraining muscles.  






Now if we understand the basics of the nervous system then understanding neural firing can be very easy.  We need to look at neural firing as the neuron that sends signals through our nerves out to the muscles or viscera.  The neuron is like a messenger.  The neuron carries the message being sent from the muscle/viscera to the brain via the spinal cord back down to the muscle/viscera.  So if there is a muscle spasm or an organ is diseased than the neuron can not fire as quickly or may not fire at all.  For an example, multiple sclerosis patients have lost their ability to fire neurons effectively because of a decrease in the number of ACH (acetylcholine) being produced at the neuromuscular junction.  This is a more complex example but demonstrates the concept of neural firing very well.  We will now look at how this applies to functional movement which is our main concern.

To begin we need to understand a few concepts about how our nervous system helps control functional movement patterns.  The central nervous system is the command center that controls and regulates all movement patterns.  Say we wanted to pick up a pencil on our desk, before the action can be preformed a signal is sent to our brain which tells the brain to conduct an action and then the signal is sent back down via the spinal cord to the muscles before the pencil is even picked up.  The central nervous system directs preprogrammed patterns of movement that can be modified to react appropriately to gravity, ground reaction forces, and momentum.  This concept is extremely important when we look at designing a training, reconditioning or rehabilitation program.  With core stabilization we will be able to retrain muscle groups to fire correctly when doing functional exercises or activities.  When a muscle becomes injured other muscle groups will protect that particular injured muscle while it heals but at the same time the other muscle groups adapt in order to perform regular movements.  For example, research has demonstrated that the transverse abdominus (a major intrinsic stabilizer of the lumbar spine) has shown decreased neural firing in individuals complaining of low back pain.  Therefore these individuals will have relied on the psoas, erector spinae and the superficial abdominal muscles to provide stability to the lumbo-pelvic-hip complex.  And what we see in individuals with low back pain is poor posture, inadequate stabilization and decreased neuromuscular efficiency as a result of decreased core strength. 

Before I had mentioned that we would look at ways to test certain muscle groups in order to see if they were weak or strong.  This correlates with neural firing and the lumbo-pelvic-hip complex which is the main focus surrounding core stabilization.  These are very basic ways to test our clients or patients muscles and how we can send a proprioceptive signal into the muscle belly to make the muscle fire again. 

A proprioceptive signal is where we can send a stimulus into the muscle in order to wake it up again.  The proprioceptive signal is sent into the golgi tendon organ of the muscle which tells the muscle to either contract or relax.  





Take the gluteus maximus and medius muscles.  Both muscles cause extension of the hip.  To test the gluteal muscles have your client or patient stand so that they are facing forward.  Then stand behind the client or patient.  Have your client or patient stand next to a wall or chair encase they need something for balance.  Ask them to raise one leg to 90 degrees with the knee bent and then repeat to the other side.  When the leg is brought up to 90 degrees we are looking to see if the opposite gluteal muscles dip down.  This simple test indicates a problem or a weakness with the gluteus medius muscle.  Since we might not choose to do this test on everyone we could look at it from another stand point.  Say you have a client or patient who complains of a muscle spasm when doing hip extension exercises on a therapeutic ball or on a machine, our first instinct is to stop and stretch the muscle.  But what if we sent a proprioceptive signal to the muscle instead of stretching the muscle?  What we are able to do is retrain the muscle and get the muscle firing again hence decreasing the spasm.  Now this is not going to be a pain-free movement for your client or patient so please address that first.  Next go ahead and have your client or patient lie on the uninvolved side with their backside facing you.  Have your client or patient lie on a mat on the floor and not a bench to ensure safety.  Next place your thumb right on the ischial tubersoity (also known as your butt bone) and ask your client if that causes the same discomfort.  Next ask your client or patient to perform hip extension while you maintain your contact and resist them from performing extension.  Hold for about five seconds then have them relax and repeat five times.  Since the area will be inflamed and sore for about 24 to 48 hours have your client or patient ice at home for about twenty minutes and have them do this three times before going to bed for the evening.  The next time your client or patient performs any action that requires hip extension the gluteus maximus and medius will fire before any other muscle fires which is what we want to happen.

Another test we can look at stems from the psoas and quadratus lumborum muscles.  We already know that the two muscles aid in core stabilization and their primary muscle action is hip flexion.  For this test you would want to ulitize a bench since you will be adding a stretch into the test.  Have your client or patient lie on their back while you stand to the side of the bench.  If your client or patient feels unsteady on the bench have them grasp the bench for additional support.  But this may be difficult because the test requires them to use their hands.  Ask the client or patient to bring one knee into their chest and hold have them hold it there with their hands for about five seconds and then have them relax.  What you are looking for is to see if the knee bends or comes up toward the ceiling of the straight leg.  If this happens it indicates that they have a tight psoas or quadratus lumborum on the straight leg side.  Repeat this to the opposite side.  You can add to this test by taking the straight leg off to the side of the bench keeping the rest of the body on the bench and put one hand over our client’s or patient’s hands while your other hand is placed on their thigh just above the knee.   Next push gently on your client’s or patient’s hands while you also push the other leg towards the floor.  Once they feel a stretch hold for five seconds. Then continue to maintain the exact position as you continue to push the leg to the floor.  Hold again for five seconds once they feel the stretch and then go into one more stretch from there.  You do this three times and every time you never release the stretch until the third stretch is completed.  What you are doing is sending a signal into the muscle by stretching instead of applying a physical contact to the area.  Again, since you might not choose to do this test with everyone of your client’s or patient’s you might notice that they have a tight psoas or quadratus when they have difficulty bringing their knee to their chest or when they try to bring both knees to their chest during stretching.  This test also works as a great stretch for these two muscles since they lie deep in the abdomen and you can not physically contact the muscle belly. 

One other test we can look at is when we have a client or patient complain of knee pain on the lateral side (outside part of the knee).  Now the muscle most likely to be effected here is the iliotibial band.  This muscle has no main connection with our core but if we look at the effect it has when it becomes too tight the connection becomes clear.  If we put our hands at our sides and run them up to where we feel our hips then we have just illustrated where the iliotibial band is located.  The iliotibial band is a thin muscle that starts up by the hip and runs down to the fibula.  We usually see tight iliotibial bands in runners.  Now if our iliotibial band is tight or in spasm then it directly effects the movement surrounding the hip, the pelvis and right up into our low backs.  You can test the iliotibial band by having the client or patient side lying on a bench with you standing behind them for support.  Have them lie on the uninvolved side.  Next ask your client or patient to abduct their leg and extend the leg behind them.  What you are looking for is the leg to stop or cause discomfort to the client or patient when performing this movement.  Once they can not go any further, place one hand on their pelvis and the other on their thigh just above the knee.  Then bring them into a stretch and hold once the stretch is felt for five seconds.  Again you are going to maintain that position as you bring them further and further into a stretch.  Repeat this three times before you have the client or patient completely relax.  If you choose not to do it this way, you can also have your client or patient lie on their side on the floor.  Again have them lie so the involved side is up and so their pelvis is perpendicular to the floor.  Place both of your thumbs over their hip joint and apply some pressure.  Remember you never want to cause any harm to our client or patient when doing any of these techniques.  While you maintain your contact ask your client or patient to bring their knee to their nose and then have them fully extend from that position.  This is going to be uncomfortable.   Perform this exercise slowly and repeat five times.  With this technique you are able to send a signal into the muscle telling the muscle to relax and stretch.     

What I have illustrated here is three techniques that you can use to send a proprioceptive signal into the injured muscle.  Even though they are simple techniques they are very useful with most of our clients and patients when it comes to retraining the injured muscle.  


For more information or questions concerning this topic contact +Heather Gansel.



An Ergonomic Overview

Companies lose billions of dollars every year, because their employees stay home with such ailments as headaches, backaches, eyestrain, sore feet and arm and wrist pain from repetitive motion. That is why ergonomics, or the science of designing the job, equipment, and workplace to fit the worker, is so important. In an ergonomically correct environment, employees are much more productive and positive about their work.

An ergonomics specialist designs and enhances the workstation, tools, equipment, and procedures to minimize fatigue discomfort and injuries, at the same time as effectively obtaining company goals. Ergonomics is also used to reduce errors, wasted motions, repairs, and materials damage. The National Institute of Occupational Safety and Health defines ergonomics as “the discipline that strives to develop and assemble information on people’s capacities and capabilities for use in designing jobs, products, workplaces and equipment.”
Ergonomics is founded on the science of the relationship of human physiology and pathology to work. Healthcare providers already have the understanding of and training in human physiology and the mechanisms of injury necessary to diminish the incidence and severity of workplace dangers. This knowledge and expertise can also be used to maximize work output of all workers, healthy and injured.


Risk Factors-

The Occupational Safety and Health Administration reports that annual workplace injuries, illnesses and deaths cost organizations $170 billion per year. Payment for accidents include direct costs to the employees and healthcare professionals and indirect costs for reduced productivity and manufacturing quality, additional training, and greater legal and insurance fees and premiums. In 2001, injuries from excessive carrying, holding, lifting, pushing, and pulling led to nearly $10 billion in direct costs and repetitive motion injuries added up to over $2 billion in direct costs. The indirect costs from these ergonomic injuries accounted for $39 billion.
There is documented a connection between workplace safety and an organization’s output and profits. Insurance claims increase and profits decline when workplace injuries mount. Enhanced safety and ergonomics can decrease injuries and improve bottom line profits. Research indicates that a good health and safety program can save $4 to $6 for every $1 invested due to greatly lowered workers’ compensation and medical costs, reduced absenteeism, turnover, and training costs, and higher productivity and employee morale.







The ergonomic changes must address risk factors, such as repetition and awkward posture, associated with individual work tasks. Some of the guidelines for office work modifications are: Designing tools and equipment to encourage workers to maintain a proper body position; choosing tools and equipment to lower muscle exertion and direct tissue pressure; reducing repetitive arm motions, long reaches and twisting motions; building working surfaces at the correct height; allowing working surfaces to be tilt adjustable; adjusting furniture to lower body strain from awkward posture; incorporating task lighting without glare and shadows; and using wrist and/or arm supports. 


Following proper ergonomics greatly helps improve employee safety and, as a result, lowers the number of days of sick leave. Quality is greatly enhanced by cutting down or eliminating the workers’ handling of components or materials during assembly or manufacture. Profitability is increased by boosting productivity. 



For more information on proper ergonomics or to have an ergonomic evaluation contact +Heather K. Gansel, DC ofHead-To-Toe Chiropractic.

Running Without Hip Pain

The most common complaint we hear from a tri-athlete after their event is, “I have extreme pain in my groin.”  By the time an athlete jumps off their bike to enter the run their legs are usually extremely heavy because their hip flexors cannot loosen nor can they stop firing.  If an athlete chooses to ignore the discomfort or the pain that has been created after the race and continues to run an overuse injury will set in. To see that this doesn’t happen to you contact Dr. Heather Gansel at 203-979-3142.


Fitness Tips for 2013

Fitness Tip #101




Did you know that jumping rope is one of the most strenuous cardiovascular workout you can give yourself?  Since it’s impossible to sustain a 30min workout with a jump rope try this instead:




·  Skip rope for three minutes. (A round in boxing is three minutes long.)


·  Take a minute off, and do as many crunches as you can.


·  Skip rope for another three minutes.


·  During the next minute between rounds, do as many push-ups as you can.


·  Back to skipping for three minutes


·  Do crunches for another minute. Repeat






Fitness Tip #102




Strong abs will improve your form, reduce injuries, and make you faster. Check out this video short video clip from Runner’s World. 









Fitness Tip #103




Strengthen your cross-body core vector to enhance performance with a medicine-ball twist exercise.  Stand erect, take a hip-width stance and hold a medicine ball between waist and shoulder level with your arms extended in front of you.  Forcefully rotate your torso to move the ball from one side to the other, keeping your core erect and your glutes engaged to help initiate and resist the rotational forces. 






Fitness Tip #104



For all you hardcore exercisers out there, did you know that chocolate milk is the best post-workout drink because it provides the perfect balance of protein and carbs to your body after a hard workout.





Fitness Tip #105


Did you know….that performing an intense weight workout before doing cardio can burn more fat during the cardio session you have after the weight workout? According to scientists weight training may trigger fat-burning hormones




Fitness Tip #106


Here are some great gym friendly proteins – 3oz of Chicken, Turkey or Tuna; 3 eggs (contains 19 grams of protein); 2% Chocolate milk (16 oz); Whey powder (30g scoop); or Greek yogurt (5.3 oz container). Reminder the muscle building ideal is 20 grams, half before and half after your workout!


Fitness Tip #107


Check out this very cool Plyo Side Plank featured on Men Health’s TV




For more fitness tips contact Dr. Heather Gansel, owner of Head-To-Toe Chiropractic.  

Common Injuries in Tri-Athletes

During the Triathlon season there are two injuries that can occur, one is rotator cuff and the other is hip flexors.  They are the most common injuries we treat at Head-to-Toe Chiropractic.  A tri-athlete’s body is under tremendous stress from the point they begin their training program in the early spring through the late fall when their bodies can be prone to injuries.
Rotator Cuff
The shoulder is a ball-n-socket joint that allows for the arm to have complete circumduction.  When swimming, whether it be in a pool, a lake or the ocean; a majority of the athlete’s strength is coming from the rotator cuff muscles.  The four rotator cuff muscles , which hold the ball part of the shoulder to the socket are the supraspinatus, infraspinatus, teres minor and the subscapularis. If one of these muscles is injured, a swimmer will have great difficulty in completing a full stroke and will begin to create an overuse injury due to other muscles stepping in to take over in order for the swimmer to complete their distance.  The two most common rotator cuff muscles to be injured are the supraspinatus and the subscapluaris.  Both muscles suffer the most wear and tear when training for long distance swims because they are used the most during the pulling stage of doing the freestyle stroke (also known as the crawl).  If an overuse injury should occur from either one of these muscles, a swimmer can experience pain (as much as radiating pain) up into the neck into the front part of the shoulder and down the arm all on the same side, sometimes into the fingers.
Rotator Cuff – The treatment protocol
The treatment protocol for both of these rotator cuff muscles involves a combination of electric stimulation, soft tissue massage, ice, active release technique, chiropractic adjustments to the thoracic spine (upper back)/shoulder/scapula/lower cervical (neck), corrective and rehabilitative exercises.
Hip Flexors
The two most common hip muscles that can limit range of motion are the iliopsoas and the psoas muscles (also known as your hip flexors).  Both muscles are responsible for hip flexion, bringing the knee to the chest. It begins with the bike race. Depending on how long an athlete is on the bike, the more the iliopsoas and psoas begin to tighten.  By the time an athlete jumps off their bike to enter the run their legs are usually extremely heavy because their hip flexors cannot loosen nor can they stop firing.  If an athlete chooses to ignore the discomfort or the pain that has been created after the race and continues to run an overuse injury will set in.  The most common complaint we hear from a tri-athlete after their event, “I have extreme pain in my groin”.  Then, they point and press deep into their hip. What typically has happened their hip flexors take over instead of their quad (primarily their rectus femoris) and their gluteus medius.
Hip Flexors – The treatment protocol
The treatment protocol for this injury involves a combination of electric stimulation to the ITB and Medial Mencius; soft tissue massage; active release technique; chiropractic adjustments to the lumbar spine (low back)/pelvis/hip/ knee; corrective and rehabilitative exercises.
For more information contact the Head-to-Toe Chiropractic office at 203-979-3142.

A Workout for Everyone!

The recent fitness craze has been over this little device called the TRX.  It has been featured in Men’s Health magazine, has been on the “Biggest Loser” and most recently has been mentioned in the Wall Street as a workout that’s easy on the joints.  It has been referred to “gym in a bag” because it is portable and you can attach it to almost anything (that’s stable and structurally sound).  The TRX was invented by Randy Hetrick (a former US navy seal and founder/CEO of Fitness Anywhere) where he saw the need to make a portable small light weight fitness tool that could enable you to work out your entire body in a tight space and virtually anywhere.

As a sports Chiropractor and owner of Head-To-Toe Chiropractic, the TRX has enabled us to take functional training to a whole other level.   The TRX hangs from a singular point in the ceiling approximately 6-8 feet off the ground where movement becomes challenging thanks to a pendulum effect meaning your core (your deep abdominal and spinal stabilizer muscles) have to be engaged constantly while you are using the TRX suspension training system.  For athletes the TRX allows us to re-create multi-planar movement that an athlete would normally do for their sport while enhancing over-all sports performance.

As a chiropractor I love the fact that the TRX system engages the core the minute you put either your hands or feet into the cradles.  Our core is such an essential part of our body that I think people forget how important it to have a strong core verses “six pack” abdominals.  This is what makes the TRX a great workout for anyone at any age because everyone could use a stronger more stable core.  And with a stronger core conditions like low back pain/discomfort disappear quicker and our bodies begin to understand what it means to engage the core in either the conscious or subconscious state.

Here at Head-To-Toe Chiropractic we use the TRX when designing personal training programs for clients as well as to re-correct muscle imbalances in athletes.  Contact Dr. Heather Gansel  @ 203-979-3142 to learn more about the TRX and ask how it can help you this winter season.